Introduction:The rate of attempted vaginal birth after previous cesarean delivery has decreased, while the success rate of such births increased. Advances in surgical techniques, the development of anesthesiology services, particularly endotracheal anesthesia, very quality postoperative care with cardiovascular, respiratory and biochemical resuscitation, significantly reduce maternal mortality and morbidity after cesarean section. Progress and development of neonatal services, and intensive care of newborns is enabled and a high survival of newborn infants. Complications after cesarean section were reduced, and the introduction of prophylaxis and therapy of powerful antibiotics, as well as materials for sewing drastically reduce all forms of puerperal infection.Goal:Goal was to establish a measurement value of the parameters that are evaluated by ultrasound.Material and methods:Each of the measured parameters was scored. The sum of points is shown in tables. Based on the sum of points was done an estimate of the scar on the uterus after previous caesarian section and make the decision whether to complete delivery naturally or repeat cesarean section. We conducted a prospective study of 108 pregnant women. Analyzed were: shape scar thickness (thickening), continuity, border scar out, echoing the structure of the lower uterine segment and scar volumeResults:The study showed that scar thickness of 3.5 mm or more, the homogeneity of the scar, scar triangular shape, qualitatively richer perfusion, and scar volume verified by 3D technique up to10 cm are attributes of the quality of the scar.Conclusion:Based on the obtained results we conclude that ultrasound evaluation of the quality of the scar has practical application in the decision on the mode of delivery in women who had previously given birth by Caesarean section.

ObjectiveThe aim of the study was to describe the prevalence of hyperlactatemia and emphasis on repeated lactate measurements in critically ill patients, and the associated mortality.Materials and methodsThe study included 70 patients admitted in the Medical Intensive Care Unit at the Clinical Center, University of Sarajevo, in a 6-month period (July - December 2015). The following data were obtained: age, gender, reason for admission, Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation, lactate concentrations upon admission, after 24 and 48 hours, and outcome (discharge from hospital or death).ResultsUpon admission,hyperlactatemia was present in 91.4% patients with a mean concentration of lactate 4.13 ±1.21 mmol/L. Lactate concentration at 48 hours was independently associated within creased in-hospital mortality (P = 0.018).ConclusionPersistent hyperlactatemia is associated with adverse outcome in critically ill patients. Lactate concentration at 48 hours is independently associated within creased in-hospital mortality and it represents a statistically significant predictive marker of fatal outcomes of patients. Blood lactate concentrations > 2.25 mmol/L should be used by clinicians to identify patients at higher risk of death.

I ntroduction: Cesarean section (Sectio Caesarea) is a surgical method for the completion of delivery. After various historical modifications of operative techniques, modern approach consists in the transverse dissection of the anterior wall of the uterus. The rate of vaginal birth after cesarean section was significantly reduced from year to year, and the rate of repeated cesarean section is increased during the past 10 years. Evaluation of scar thickness is done by ultrasound, but it is still debatable size of thick scar that would be guiding "cut-off value" for the completion of the delivery method. Goal: The aim was to examine the most accurate ultrasonic method for assessing thickness scar on the uterus after previous cesarean delivery and determine the threshold thickness of scar that would allow the completion of birth vaginally. Material and methods: Conducted is prospective study of 108 pregnant women aged 20-42 years, who had previously had a Caesarean section. Diagnostic accuracy in assessing the success of scar scale by evaluation of delivery (spontaneous or caesarean section). Measurements were carried out by 2D and 3D ultrasound machines in the 20, 38-40 week of gestation and 48 hours after birth. Results: Tests have shown that there is a statistically significant difference in the rates of specificity (0.04), sensitivity (0.05), PPV (0.01) and NPV (0.01) between 2D and 3D ultrasound. Ultrasound images of uterine muscle scar after prior cesarean section are better by 3D methods. The marginal value, "cut-off value" thick scar, which provides the possibility of vaginal birth after previous incision was 3.5 mm. Conclusion: The study showed that ultrasound measurement of 3D ultrasound thick scar on the uterus after previous cesarean section has practical application in determining the mode of delivery among pregnant women who have previously given birth by Caesarean section.

The time in which we live is defined by the significant influence of the information technologies on our lives, changes and development of society and the efficacy of all the organization systems. Increase and development of distance learning (DL) technologies over the past decade has exposed the potential and the efficiency of new technologies. Number of events has organized by teaching staff from Cathedrae for Medical Informatics in order to promote distance learning and web based education are very extensive: professional-scientific events, workshops and congresses, first tele-exam at the Medical Faculty, Introducing of Distance learning in curriculum at biomedical faculties, etc. At the University in Sarajevo in year 2003 was opened the e-learning center for the support to the faculties the distance studies by use of the information technology. At Medical Faculty of University of Sarajevo at Cathedrae for Medical Informatics since 2002 is in progress realization of the project named: "Possibilities of introducing distance learning in medical curriculum", approved by the Federal and the Cantonal ministry of science and education. Pilot project was realized during three past school years, theoretical and practical education of subject Medical informatics are adapted to the new concepts of education using world trends of education from the distance. One group of students was included in the project finalized by electronic exam registration and electronic exam on 20 June 2005, publicly, in the Physiology amphitheatre of the Medical Faculty in Sarajevo.

Introduction: Preeclampsia is defined as hypertension (systolic pressure ≥140 mmHg or diastolic pressure ≥90 mmHg) after week 20 of gestation with one or more of the following symptoms: proteinuria, organ dysfunction (including renal, hepatologic, hematologic or neurological complications) and in case of stagnation of fetal development. So far, there are no valid clinical tools or tests that can tell with sufficient sensitivity and specificity in early pregnancy which pregnant woman will develop preeclampsia or have unwanted outcomes. Aim: To present the properties of biochemical parameter, uric acid, in patients with signs of preclampsia, which was confirmed by Doppler sonography. Methods: The study included 60 female subjects in the second trimester of pregnancy who were examined or were hospitalized at the

Introduction:Hypertension (high blood pressure) is one of the most widely spread modern diseases and one of the leading risk factors for heart and blood vessel diseases, particularly stroke and coronary heart disease. The prevalence of hypertension is about 25% in adults. Many studies show that blood pressure tends to have lower values among people with higher education levels.Goal:To determine the frequency of measurement and control of blood pressure in relation to the level of education of the active working population of the Sarajevo Canton.Material and methods:The study was conducted on 443 subjects randomly selected from the categories of the active working population of the Sarajevo Canton. The study was conducted at the Center for Heart, Clinical Center University of Sarajevo University through the project “Prevention of risk factors for cardiovascular disease in the active working population of the Sarajevo Canton”. Respondents were at age in range from 18-65 years, who have voluntarily joined the study.Results:Of 443 (100%) of the respondents 153 (34.5%) were males compared to females whose participation in the sample was 290 (65.5%). Regarding the structure of respondents, the majority of them 213 (48.1%) graduated faculty, 142 (32, 1%) graduated secondary vocational schools and 66 (14.9%) with a higher degree, with the lowest number with completed grammar school (1.4%) and secondary school (0.5%). Blood pressure never measure 16 (3.6%) of respondents, which is not insignificant number, more than 5 years ago 23 (5.2%), within last 1-5 years 90 (20.3%), in the past 12 months 88 (19.9% ) and 226 (51%) measured the blood pressure in the past 6 months. Blood pressure never controlled 4.33% of respondents with secondary or higher education and 2.82% of the respondents with university education. Chi-square test showed a difference between education and the prevalence of blood pressure, χ2=7.812; DF=8; p=0.045.Conclusion:Monitoring of blood pressure and frequent measurement can in large number prevent progression of hypertension, which can often remain unnoticed if the blood pressure is not measured regularly. Lower levels of education may be associated with lower socioeconomic status of healthy subjects, as well as the low level of health education, which may be factors that contribute to improper diet, lack of physical activity, smoking, so indirectly affect the occurrence of the disease. Education can be a potential risk factor for high blood pressure during their lifetime and thus the risk factor for other cardiovascular diseases.

Menstrual cycle disturbancies (oligomenorrhea and secondary amenorrhea) in patients with hyperprolactinemia and infertility occured in 40.33% of patients. We have noted statisctically significant correlation between the serum prolactin levels on the day 8 of menstrual cycle and the microadenoma size, which was not found on the 21 day of menstrual cycle.

Introduction: The effect of statins on risk of heart failure (HF) hospitalization and lethal outcome remains dubious. Aim: To investigate whether statin therapy improves clinical outcomes in patients hospitalized for ischemic heart failure (HF), to compare the efficacy of lipophilic and hydrophilic statins and to investigate which statin subtype provides better survival and other outcome benefits. Material and Methods: Total amount of 155 patients in the study were admitted to the Clinic for Cardiology, Rheumatology and Vascular diseases in Clinical Center University of Sarajevo in the period from January 2014- December 2017. Inclusion criteria was HF caused by ischemic coronary artery disease upon admission. For each patient the following data were obtained: gender, age, comorbidities and medications on discharge. New York Heart Association (NYHA) class for heart failure was determined by physician evaluation and left ventricle ejection fraction (LVEF) was determined by echocardiography. The patients were followed for a period of two years. Outcome points were: rehospitalization, in-hospital death, mortality after 6 months, 1 year and 2 years. All-cause mortality included cardiovascular events or worsening heart failure. Results: Overall, 58.9% of HF patients received statin therapy, with 33.9% patients receiving atorvastatin and 25.0% rosuvastatin therapy. The most frequent rehospitalization was in patients without statin therapy (66.7%), followed by patients on rosuvastatin (64.1%), and atorvastatin (13.2%), with statistically significant difference p = 0.001 between the groups. Mortality after 6 months, 1 year and 2 years was the most frequent in patients without statin therapy with a statistically significant difference (p = 0.001). Progression of HF accounted for 31.7% of mortality in patients without statin therapy, 12.8% in patients on rosuvastatin therapy and 3.8% in patients on atorvastatin therapy (p = 0.004). Conclusion: Lipophilic statin therapy is associated with substantially better long-term outcomes in patients with HF.